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Quality and Productivity in  Mental Health - Dr Bhaumik
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Quality and Productivity in Mental Health - Dr Bhaumik


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  • 1. Quality & Productivity (QIPP) in Mental Health Dr. Sabyasachi Bhaumik Medical Director, Leicestershire Partnership NHS Trust Honorary Senior Lecturer, University of Leicester
  • 2. THE BACKGROUND 1. History of mental health services a. Shift towards community based care. b. Closure of beds 2. NSF (1999) a. Social inclusion & community based care b. New specialist teams – AOT, CRHT, PIER etc c. Evidence based practice d. Improving access – IAPT 3. New Horizons a. Prevention & early intervention b. Interagency working
  • 3. Need for efficiency – why now?  Economic downturn & its implications  Projected efficiency savings - £15-20bn by 2013/14  Implications of zero based budgets  Mental health – 13.8% of health budget  Direct and indirect costs of poor mental health - £77 bn
  • 4. Threats & opportunities  Threats  Decommissioning  Tendering  Competition from other sectors  Drive towards value for money – efficiency  Opportunities  Autism Act  National Dementia Strategy  Long term conditions  MUS  GP commissioning  PbR
  • 5. QIPP as part of efficiency  Drivers for efficiency  CIPs  Decommissioning  PbR  Tendering  Vehicles for efficiency  CQUIN  Carepathways  QIPP
  • 6. What is QIPP?  Quality  Innovation  Prevention  Productivity  Steered by DoH, National Mental Health Development Unit, Audit Commission, NHS Confederation and Mental health Networks
  • 7. QIPP framework National Indentifying levers & setting the agenda – CQUIN, PbR, services for MUS etc Providing support & advice for change Developing partnerships Co-ordinating programmes of change at scale Local & Regional Redesigning systems & pathways Innovations Sharing of audit data between commissioners and providers Benchmarking and evidence building
  • 8. The main principles underpinning QIPP in mental health  Care close to home.  Fewer acute beds.  Reduced variations in care.  Standardization of Care pathways.  Early Intervention.  Productivity.
  • 9. Three major areas for QIPPMH 1. Supporting improvements in the acute care pathway 2. Out of area placements. 3. Physical / mental health interface – including how mental health can support colleagues working in the acute and primary care sector on areas like tackling medically unexplained symptoms and improving liaison services.
  • 10. Examples of innovative practice  Releasing time to care (Rampton Hospital)  A series of steps designed by staff within the ward  Each step has an incentive for the staff  Increase in staff morale  Reduction in sickness from 14% to 1.1%  More efficient ward means better patient care and patient satisfaction
  • 11. Examples of innovative practice  Early discharge  Underpinned by productive mental health ward  Staff initiated process review  Achieved reduction in paper work  Improvement in in-patient & community coordination  Reduction in readmission rate (400% increase in successful early discharge)
  • 12. Examples of innovative practice  Intensive Home Intervention Team (Edinburgh)  Problems with high bed occupancy & revolving door patients  Resolved through creative IHIT combining the functions of AOT and CRT  60% reduction in bed occupancy  94% user satisfaction
  • 13. Further themes of innovative practices Adult mental health: Bringing NSF teams together AOT for revolving door patients e-prescribing generic prescribing e-communication with GP’s Admin support MHSOP: Long term care model Dementia prescribing with primary care Nurse led cognitive assessment team
  • 14. Further themes of innovative practices CAMHS: Joint working with Paediatricians NWW Mental health care workers with primary care LD: Care pathways and PbR NWW Tiered care model Partnership with voluntary organisations, independent sector and social care services Out of area placements
  • 15. Future  Commissioning driven by quality of patient experience  PbR for mental health in place by 2013/14  GP commissioning in place by 2013  Partnerships in service provision  Total place  Transforming Community Services QIPP is here to stay!!